Treatment and HIV prevention


    The AIDS Committee of Toronto (ACT) believes that HIV testing and treatment should be offered to all people living with HIV, but no one should be forced to undergo either. No response to HIV can work without the engagement and voluntary participation of people living with and at increased risk of HIV.

    ACT supports universal access to anti-retroviral (anti-HIV) drug therapy and other treatments for HIV/AIDS, in Canada and around the world. ACT believes that access to HIV treatment is a right of all people living with HIV/AIDS.

    Recently, discussion has emerged regarding the potential of anti-retroviral treatment to be used as an HIV prevention tool. Some researchers have projected that universal application of anti-retroviral treatment could stop the global HIV epidemic in its tracks, by reducing viral load and infectiousness among those living with HIV.1

    ACT supports a comprehensive approach to HIV prevention and treatment. Universal access to HIV treatment is a part of the HIV prevention response. However, any response must respect the health and human rights of people living with and at risk of HIV, and be delivered in combination with other HIV prevention methods, including:
    • access to condoms (male and female/receptive) and other barriers;
    • the development of microbicides (for both vaginal and anal use);
    • pre- and post-exposure prophylaxis;
    • voluntary, confidential and anonymous testing for HIV and other sexually transmitted infections; and,
    • needle exchanges and other harm reduction initiatives.
    While ACT supports the laudable goal of increasing access to HIV treatment, and the concurrent role it can play in HIV prevention, we remain concerned about:
    • Treatment in settings without adequate viral load testing to identify cases of treatment failure, which could result in undetected viral rebound;2
    • Treatment in settings without access to second-line (ie newere) anti-HIV drug regimens which could result in increased transmission of drug-resistant HIV;2
    • The application of drug treatments that lower infectiousness, but are not medically necessary, which may have negative health impacts on those living with HIV/AIDS;3 and,
    • Universal application of treatment which violates the human rights of people with HIV/AIDS by removing the choice of when to begin anti-retroviral therapy.

    References:
    1 Montaner JSG et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. The Lancet 368: 531-536, 2006.
    2 Alcorn, Keith. Treatment as prevention tool: enough evidence to say it works, says IAS president. <http://www.aidsmap.com/en/news/30D49BD7-41FC-4E0D-AEBD-A210794D0533.asp>
    3 O’Neal, Reilly. Is HIV treatment HIV prevention? <http://www.thebody.com/content/art54536.html>